Thyroid Flashcards
Hyperthyroidism
T3 and t4 ↑
And TSH ↓
Hyperthyroidism Tx
Methimazole ( tapanzole)
Propylthiouracil ( PTU )
Dont work right away. Need to give meds to help sx right away
Side effects of 2 major: agranulocytosis and hepatoxicity ( PTU is severe ) methimazole preferred. And more efficacious
In pregnancy: only first line is PTU in first trimester of pregnancy
BBW for PTU
Severe hepatotoxicity
Monitoring for hyperthyroid meds
CBC
Do not use if baseline ANC <500
LFTs
Other hyperthyroidism tx
Radioactive tx : RAI destruction of thyroid slow onset
Thyroidectomy
Lugos solutions: blocks hormone release ( thyroid storm ), rapid relief symptomatic
Beta blocker
Diltiazem
Cholestyramine
Hypothyroidism
Causes: hashimotos ( auto immune)
Drug induced
Low T3 & T4 and High TSH
All PO medication for hypothyroidism is pregnancy category
A
If patient gets pregnant we up their dose 25%
Armour thyroid
Dried pig thyroid powder
T3 and t4
Levothyroxine
Synthetic t4
Levoxyl, synthroid, tirosint ( soft gel capsule ), unithroid
Slow onset
Advantage: long half life
Liothyronine
Cytomel, and Triostat
Synthetic pure T3
Advantage rapid absorption, rapid onset.
Disadadvantage t3 doesn’t last long, have take it multiple times a day
Liotrix
Thyrolar
Synthetic t4 and t3
Advantage : short and long acting effects
Disadvantage : expensive
Ratio of t4 : t3 is 4: 1 ratio
TSH goal range
0.35 to 5
Endocrinologist want 0.3 to 3
Levothyroxine in IV is in
NS
LevothyroxiNe
IV is 50 - 75% of the oral
Use immediately
In pregnancy PTU is preferred in the first trimester of pregnancy and what is preferred for 2nd and 3rd trimester?
Methimazole.
Methimazole not preferred in 1st trimester due to risk of congenital anomalies
What drugs can cause hyperthyroidism ?
Iodine
Amiodarone
Interferon alpha
Interleukin 2
Alemtuzumab
Pembrolizumab
